Provider Demographics
NPI:1508108341
Name:SMITH, SIDNEY ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:ANDREW
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5224 BLUE CYPRESS LN
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-6242
Mailing Address - Country:US
Mailing Address - Phone:281-557-0108
Mailing Address - Fax:
Practice Address - Street 1:1414 HOLLAND ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77029-2846
Practice Address - Country:US
Practice Address - Phone:713-453-0404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9670208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC21948Medicare UPIN